ISSN:1075-2765    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

At the University of Illinois Hospital, antibiotic susceptibility testing was retrospectively performed on 254 stored clinical methicillin-resistantStaphylococcus aureus(MRSA) isolates cultured from 1985 through 1990 to characterize resistance to ciprofloxacin and other antibiotics. In case-control analyses, inpatients with and without ciprofloxacin-resistant strains were compared. Ciprofloxacin-resistance increased from 7% before 1988 to 83% in 1990. A sudden increase in resistance to trimethoprim-sulfamethoxazole also occurred in 1988, and by 1990, 65% of strains were resistant to both antibiotics. In 95 patients with recent MRSA isolation (70 acquired nosocomially, 25 acquired in the community), ciprofloxacin resistance was more common in the nosocomial group (80%v60%,P< 0.05). In that group, no host or in-hospital factors were associated with ciprofloxacin resistance. Among community cases, a greater proportion with ciprofloxacin-resistant MRSA had diabetes mellitus (60%v0%,P= 0.002). Thus, with use, ciprofloxacin resistance emerged rapidly in MRSA and developed particularly among strains resistant to trimethoprirn-sulfamethoxazole. Combined resistance to these antibiotics, uncommon in previous reports, severely limits oral therapy as an option for MRSA carriage or infection.

ISSN:1075-2765    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The effects of metoclopramide, labetalol, and metoclopramide plus labetalol treatments on baseline cardiovascular parameters and isometric handgrip-induced changes were evaluated in 11 hypertensive subjects. Although all treatments were effective in reducing resting systolic (SBP) and diastolic (DBP) blood pressures, the combination of metoclopramide and labetalol appeared to provide a greater decrease (changes in SBP/DBP: 15/11 mm Hg,P< 0.05; from 149 ± 4/95 ± 4 mm Hg to 134 ± 5/84 ± 3 mm Hg) than did labetalol alone (changes in SBP/DBP: 10/9 mm Hg,P< 0.05; from 149 ± 4/95 ± 4 to 139 ± 4/86 ± 3 mm Hg). At 2 minutes, handgrip increased blood pressure on placebo (changes in SBP/DBP: 34/7 mm Hg,P< 0.001). In the presence of metoclopramide and metoclopramide plus labetalol, however, handgrip induced lesser increases in blood pressure (changes in SBP/DBP: 23/7 mm Hg,P< 0.01, and 18/4 mm Hg,P< 0.01, for metoclopramide and metoclopramide plus labetalol treatments). We conclude that (1) metoclopramide lowers blood pressure in hypertensive patients; (2) metoclopramide attenuates blood pressure response to isometric handgrip; and (3) both compounds, labetalol and metoclopramide, seem to have a pharmacologic interaction concerning blood pressure decrease. A clinical significance is suggested for the metoclopramide effect.

ISSN:1075-2765    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Guidelines for the prescription of nonsteroidal anti-inflammatory drugs (NSAIDs), drawn in the Health Ministry and published by the Drug Regulatory Agency, were introduced in the emergency department of a university hospital. The main objective was to determine, in this prospective, before-and-after study, whether a teaching program could help doctors improve their NSAID prescribing practices. Correct prescribing included limiting NSAIDs to their most admitted indications, avoiding their prescription to accident-prone patients, and reducing treatment duration and daily dosage. An overall reduction of NSAID prescriptions was also expected. Prescribing errors were divided into violations (prescribing when unwarranted or against a contraindication) and inadequacies (if the compound or treatment schedule was not suited to the condition addressed). We measured the effect of the intervention 45 days after its initiation. Twenty-seven doctors participated in the two study phases (595 and 520 patients) and wrote 50 NSAID prescriptions in each (8.4% and 9.6% of patients, respectively;P= 0.44). Prescribing errors decreased from 20% to 14% of cases (P= 0.60). There was a trend toward more prescriptions conforming to the Drug Regulatory Agency guidelines (P= 0.08). Treatment duration decreased from 10.4 ± 5.4 to 9.0 ± 4.0 days (P= 0.03). The teaching of guidelines has helped physicians to improve their NSAID prescribing practices; however, it did not succeed in curbing the overall prescription rate. Unrestricted lists that include soft indications may influence younger doctors into prescribing more NSAIDs.

ISSN:1075-2765    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The aim of this study was to determine whether angiotensin-converting enzyme inhibitor administration improves the endothelial function of patients with previously untreated essential hypertension. Using high-resolution ultrasonography, we measured the arteria brachialis diameter at rest, during reactive hyperemia (endothelium-dependent flow-mediated dilatation [FMD]), and after sublingual nitroglycerin (endothelium-independent dilatator). Twenty-one previously untreated hypertensive patients participated in the study (13 men, 8 women; mean age, 39.1 ± 15 years). In the 21 patients, the basal FMD was 5.02% ± 4.1%. Two hours after the first 10-mg benazepril dose, the FMD was 6.67% + 3.9%, and after 1 month of daily 10-mg benazepril administration, the FMD was 5.59% ± 2.9%. These changes were not significant compared with the baseline value. Nine patients had relatively normal FMD (>5%), whereas the other 12 patients had abnormal FMD (<5%) at baseline. In the latter group, the first 10 mg benazepril produced significant improvement in FMD, from 2.4% ± 2.5% to 5.08% ± 2.4% (P< 0.05), but 10 mg benazepril daily for 1 month resulted in no further improvement (4.78% ± 2.7%) compared with the acute effect. No difference was found between groups with regard to age, gender, blood pressure, blood lipids, and basal arteria brachialis diameter. The previously untreated patients with essential hypertension have endothelial dysfunction, but individual differences were found. The angiotensin-converting enzyme inhibitor treatment improves endothelial function only in those patients who had endothelial dysfunction before the treatment.

ISSN:1075-2765    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The efficacy and acceptability of 5 mg nebivolol once daily, a long-acting, vasodilating cardioselective β blocker that additionally facilitates the L-arginine/nitric oxide system, was assessed in a double-blind, randomized trial in comparison with 20 mg nifedipine retard twice daily in patients with essential hypertension. At 2 weeks of treatment, nebivolol was significantly more effective. Thereafter, both drugs effectively and similarly lowered systolic and diastolic pressures without orthostatic effect. Nebivolol had a trough-to-peak antihypertensive effect ratio of 90%. Nifedipine gave the expected side effects of headache, flushing, and edema. Nebivolol was well tolerated. Nebivolol slightly but significantly lowered heart rate. Neither drug adversely affected plasma levels of lipids.

ISSN:1075-2765    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The objective of this study was to compare the efficacy and safety of Claritin-D 24 Hour (once daily) with that of Claritin-D 12 Hour (twice daily) and placebo in the treatment of patients with seasonal allergic rhinitis (SAR). In this double-blind, placebo-controlled, multicenter study, 469 patients with moderate-to-severe SAR symptoms were treated for 2 weeks with one of the following: Claritin-D 24 Hour (a combination tablet formulation of loratadine 10 mg in the coating and pseudoephedrine sulfate 240 mg in an extended-release core), Claritin-D 12 Hour (a combination tablet formulation of loratadine 5 mg in the tablet coating and 120 mg pseudoephedrine sulfate, 60 mg in the coating and 60 mg in the core), or placebo. Claritin-D 24 Hour and Claritin-D 12 Hour were consistently superior to placebo (P< 0.01) in reducing total, nasal, and nonnasal symptom scores. Patients in the Claritin-D 24 Hour and Claritin-D 12 Hour groups also had significantly greater (PlE 0.05) relief of rhinorrhea and nasal stuffiness as compared with placebo. Insomnia was reported significantly more often (P< 0.01) in Claritin-D 12 Hour (15%) patients compared with Claritin-D 24 Hour (4%) and placebo (2%) patients. Dry mouth was reported significantly more often (P< 0.05) in Claritin-D 24 Hour (13%) and Claritin-D 12 Hour (13%) groups compared with placebo (4%). Claritin-D 24 Hour has efficacy comparable to Claritin-D 12 Hour in relieving allergic rhinitis symptoms while producing significantly less insomnia.

ISSN:1075-2765    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Helicobacter pylori is a gram-negative bacterium that was first isolated in 1982. In the years following its discovery,H. pyloriinfection in humans has been shown to be associated with gastritis, peptic ulcer disease, and gastric carcinoma, as well as other, nongastrointestinal disorders. The epidemiology, transmission, and virulence factors of this bacteria have been an area of intense study. Successful treatment improves cure rates of gastritis and ulceration of the stomach and duodenum. Treatment with antimicrobials also decreases the recurrence rates of these diseases. Clinicians have numerous diagnostic tools and treatment options at their disposal. Vaccination in high-endemic areas may be available in the near future. Here, we review the pharmalogical basis of these treatment options, including their efficacy and economic considerations.

ISSN:1075-2765    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a commonly prescribed and over-the-counter class of drugs in the United States, with widespread use for various indications. The increased risk of gastrointestinal toxicity with the use of nonsteroidal medications has been well recognized. Pathogenesis of nonsteroidal toxicity is direct as well as systemic, secondary to prostaglandin inhibition. There are several risk factors to identify patients at a high risk for nonsteroidal toxicity. NSAID-related ulcer complications can be reduced by prophylaxis with prostaglandin analog drugs such as misoprostol or high-dosage proton-pump inhibition.

ISSN:1075-2765    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

In children, general anesthesia is usually chosen as the primary technique during lower extremity orthopedic procedures. Certain situations or underlying conditions may be present, however, that make the conduct of general anesthesia more difficult or even relatively contraindicated. We present 10 patients with underlying conditions or circumstances that may increase the risk of general anesthesia. Regional anesthesia (spinal or epidural) was used to provide surgical anesthesia, thereby eliminating the need for general anesthesia. The techniques used and the applications of regional anesthesia during orthopedic procedures in children are discussed.

ISSN:1075-2765    

出版商:OVID    

年代:1998

数据来源: OVID